Elucidating Social Determinants and Mental Health Needs to Achieve Equity in Rheumatic Disease Care

项目总结/摘要 风湿性疾病系统性红斑狼疮，类风湿性关节炎，骨关节炎一起 影响了美国四分之一的人口，带来了巨大的身体、社会、心理和经济损失。 负担在这些疾病的患者中， 妇女和历史上被边缘化的人口受到严重影响。问题社会决定因素 健康（SDoH），包括社会风险因素，如粮食不安全和财政紧张，以及潜在的 这些风险的缓冲，如社会支持，尚未作为风湿病护理的一部分进行常规评估 直接影响风湿性疾病患者的健康，并可能加剧不平等。那些 患有这些风湿性疾病的人更有可能患有心理健康状况，特别是 严重抑郁症和创伤后应激障碍（PTSD），新兴的研究指出， 精神疾病和自身免疫性风湿病的遗传易感性。许多个人 风湿性疾病患者没有得到及时、高质量的护理或充分的预防性保健 导致急诊科就诊和住院的增加， 结果包括疫苗可预防的感染和主要心血管事件。利用所有 我们的数据来自一个庞大而多样化的美国人口，我们提出了新的研究，以解决可修改的障碍 风湿性疾病患者是一个独特的高危人群， 这些疾病和历史上被边缘化的人口造成的身体和经济负担， 影响。到目前为止，SDoH和心理健康状况的影响，以及潜在的缓冲因素， 可以被优化，却没有得到很好的检查和解决。我们将调查这些关键问题 我们所有人中的问题，超过50，000名患有风湿性疾病的人与相关的电子健康 记录，关于SDoH的调查，人口统计学，医疗保健访问和基因分型数据。之间 对于患有风湿性疾病的个体，我们将1）使用社会风险因素指数来评估SDoH的效果 2）检查抑郁症和创伤后应激障碍对可避免的 住院和心血管事件，考虑到社会因素。我们将使用经过验证的 抑郁症和创伤后应激障碍的多基因风险评分，以了解 患有风湿性疾病的个体，并评估高遗传风险对急性护理使用的影响 未确诊未治疗疾病的标志物我们的发现，了解这些因素的相互作用， 研究不足的因素，将使干预措施开始，以实现公平的照顾和结果， 最易受风湿性疾病的影响。

PROJECT SUMMARY/ABSTRACT The rheumatic diseases systemic lupus erythematosus, rheumatoid arthritis, and osteoarthritis together affect up to one-quarter of the U.S. population, with huge physical, social, psychological and financial burdens. Profound disparities in care and outcomes are seen among those afflicted with these diseases, with women and historically marginalized populations disproportionally impacted. Social determinants of health (SDoH) including social risk factors such as food insecurity and financial strain, as well as potential buffers of these risks such as social support, are not routinely assessed as part of rheumatology care yet directly impact the health of individuals with rheumatic diseases and likely exacerbate disparities. Those suffering with these rheumatic diseases are much more likely to have mental health conditions, notably major depression and post-traumatic stress disorder (PTSD), and emerging research points to shared genetic predisposition to mental health disorders and autoimmune rheumatic diseases. Many individuals with rheumatic diseases do not receive timely, high-quality care or adequate preventive healthcare resulting in increased emergency department visits and hospitalizations for oftentimes avoidable outcomes including vaccine-preventable infections and major cardiovascular events. Leveraging All of Us data from a large and diverse U.S. population, we propose novel studies to address modifiable barriers to healthcare access and outcomes for patients with rheumatic diseases, a unique at-risk group due to the physical and financial burdens of these diseases and the historically marginalized populations most affected. To date, the influence of SDoH and mental health conditions, and potential buffering factors that could be optimized, have been poorly examined and little addressed. We will investigate these crucial questions within All of Us with >50,000 individuals with rheumatic diseases with linked electronic health records, surveys regarding SDoH, demographics, healthcare access, and genotyping data. Among individuals with rheumatic disease, we will 1) use a social risk factor index to assess the effects of SDoH on recurrent, avoidable acute care use and 2) examine the impact of depression and PTSD on avoidable hospitalizations and cardiovascular events, accounting for social factors. We will employ validated polygenic risk scores for depression and PTSD to understand differences in genetic risk among individuals with rheumatic diseases and assess effects of high genetic risk on acute care use as possible markers for undiagnosed, untreated disease. Our findings, understanding the interplay of these understudied factors, will allow interventions to begin to achieve equitable care and outcomes for those most affected by the rheumatic diseases.